Do Medical Aids Cover Psychotherapy?
Psychotherapy is the treatment of mental disorders through communication between a client and a trained mental health professional. The treatment process usually involves regular sessions over an extended period.
South African medical schemes by law must provide Prescribed Minimum Benefits (PMBs) for common mental health disorders that are considered chronic conditions. Other mental health cover depends on the specific medical scheme and the benefit structure that a person belongs to.
This fund offers a sliding scale of mental health benefits which are limited per family and per year. They are subject to pre-authorisation and there are sub-limits for consultations in and out of hospital.
– Standard, BonSave, BonClassic and BonComprehensive offer premium benefits
– BonCapprovides cover for PMBs only, subject to the BonCap GP network
– BonEssential is in-hospital only
Mental health benefits on all plans offer 21 days for each person. The Allied, Therapeutic and Psychology Benefit offers out-of-hospital services which are paid using day-to-day benefits up to an annual limit.
– Executive, Comprehensive and Priority fall under the Allied, Therapeutic and Psychology Benefit and extended cover is available.
– Claims for Saver Plan are subject to available funds in the Medical Savings Account
– Core Series members are responsible for out-of-hospital claims
– KeyCare has no cover for day-to-day benefits
Major medical benefits for psychiatric services are limited per family per year. All hospitalisation costs are covered subject to pre-authorisation.
– Maxima Entryzone is for PMBs only
– All Ultima and Maxima (excluding Entryzone) operate on a sliding scale
Day-to-day benefits are provided for using funds from the Out-of-Hospital Expenses Benefit (OHEB). Additional medical services operate on a sliding scale per family per year but are subject to OHEB and Safety Net.
– All Ultima and Maxima (excluding Entryzone and Core)
Additional chronic conditions are covered on a sliding scale per beneficiary and are subject to an overall limit per family per year.
– All Ultima and Maxima (excluding Entryzone, Core and Basis)
All plans include hospitalisation on a sliding scale andrelated costs, from admission to discharge, are covered, provided there is pre-authorisation. Day-to-day benefits are subject to the Health Saver.
– Ingwe and Access do not cover day-to-day benefits
– Custom offers day-to-day benefits
– Incentive has 10% of your contribution going to the Health Saver
– Extender has 25% of your contribution going to the Health Saver
– Summit has benefits paid at 100% of the scheme rate, subject to an annual limit and an overall limit per beneficiary.
All options provide for psychiatric disorders but are limited to network providers and are subject to PMBs and scheme protocols.
– Supreme, Millennium and Classic offer non-PMBs limited per family per year and in-hospital benefits are subject to pre-authorisation.
There are additional out-of-hospital benefits for psychology and psychiatric treatments.
– Supreme has sub-limits per family and 100%of scheme rate is subject to annual limit
– Millennium is subject to the Medical Savings Account and Above Threshold Benefit
– Classic has day-to-day limits
– Progressive Flex benefit applies to primary and additional member
– Foundation is limited to PMBs at provincial facilities
Many medical aids offer comprehensive cover for psychotherapy but it’s imperative to check with your specific scheme to determine the mental health benefits you’ll receive.